Scientists Identify What Makes Us Feel ‘Bad’ When We’re Sick, How to Treat It

From the 3 August 2011 Science Daily article

ScienceDaily (Aug. 3, 2011) — A signaling system in the brain previously shown to regulate sleep is also responsible for inducing lethargy during illness, according to research conducted at Oregon Health & Science University Doernbecher Children’s Hospital.

This research is particularly meaningful because it implies that a new class of drugs developed to treat sleep disorders can reverse the inactivity and exhaustion brought on by acute illness. Although the sleep drugs were initially designed to treat narcolepsy, they have the potential to restore energy and motivation in patients with acute and chronic disease, the researchers report. Their findings are published in the The Journal of Neuroscience.

“We all know what it means to feel ‘bad’ when we’re acutely ill. In particular, patients with chronic diseases experience a compromise in motivated behaviors. They don’t feel like getting up and doing anything. Yet the brain mechanisms behind this common experience have remained obscure,” said Daniel L. Marks, M.D., Ph.D., principal investigator and associate professor of pediatrics in the Papé Family Pediatric Research Institute at OHSU Doernbecher Children’s Hospital….

 

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The benefits of successful patient self-management programs

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From a 22 July KevinMD.com posting by Mark Novotny, MD

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can be taught to patients in formal programs, without doctors. Coordinating these activities with what goes on a primary care office, and the community, and other care-giving settings is critical. These specific skills involve patients setting their own goals, and then creating plans to reach those goals with the assistance of their primary care team and others, but not at the direction of their primary care team. This is a real mind shift for the primary care doctor also.

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Older lesbians, gays have higher rates of chronic disease, mental distress, isolation

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Older lesbians, gays have higher rates of chronic disease, mental distress, isolation

From the March 29 2011 Eureka news alert

ScienceDaily (Mar. 29, 2011) — Members of California’s aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to new policy brief from the UCLA Center for Health Policy Research.

Half of all gay and bisexual adult men in California between the ages of 50 and 70 are living alone, compared with 13.4 percent of heterosexual men in the same age group. And although older California lesbians and bisexual women are more likely to live with a partner or a family member than their male counterparts, more than one in four live alone, compared with one in five heterosexual women.

A lack of immediate family support may impact aging LGB adults’ ability to confront statistically higher rates of diabetes, hypertension, poor mental health, physical disability and self-assessed fair or poor health, compared with demographically similar aging heterosexual adults.

The study, which draws upon three cycles of data from the biennial California Health Interview Survey (CHIS), underscores the importance of considering these unique needs and chronic health conditions in providing health care and social services to the estimated 170,000 self-identified aging LGB adults in California — a population that will double in size over the next 20 years.

“Many aging LGB Californians do not have biological children or strong family support,” said Steven P. Wallace, the lead researcher on the project. “Organizations that serve these communities need to take this into account and consider outreach and support mechanisms that enable these individuals to maintain their independence and ability to age safely and in good health.”

The policy brief, “The Health of Aging Lesbian, Gay and Bisexual Adults in California,” includes the first data published on aging LGB adults based on a large statewide population. And among a population whose health needs are too often associated only with HIV and AIDS, the study offers the first insights about broader health conditions and trends….

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Guided care reduces the use of health services by chronically ill older adults

Guided care reduces the use of health services by chronically ill older adults

From the March 14 2011 Science Daily news item

ScienceDaily (Mar. 14, 2011) — A new report shows that older people who receive Guided Care, a new form of primary care, use fewer expensive health services compared to older people who receive regular primary care.

Research published in the March 2011 edition of Archives of Internal Medicine ***found that after 20 months of a randomized controlled trial, Guided Care patients experienced, on average, 30 percent fewer home health care episodes, 21 percent fewer hospital readmissions, 16 percent fewer skilled nursing facility days, and 8 percent fewer skilled nursing facility admissions. Only the reduction in home health care episodes was statistically significant.

According to the study, Guided Care produced even larger reductions in a subset of patients who received their primary care from one well managed health system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52 percent fewer skilled nursing facility days, 47 percent fewer skilled nursing facility admissions, 49 percent fewer hospital readmissions, and 17 percent fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant….

More information about Guided Care is available at  twww.GuidedCare.org.
From the Web site…”Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care nurse, based in a primary care office, works with 2-5 physicians and other members of the care team to provide coordinated, patient-centered, cost-effective health care to 50-60 of their chronically ill patients. The Guided Care nurse conducts in-home assessments, facilitates care planning, promotes patient self-management, monitors conditions monthly, coordinates the efforts of all health care professionals, smoothes transitions between sites of care, educates and supports family caregivers, and facilitates access to community resources. ”

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